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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 875-876

Addressing the oro-dental needs of patients with cancer amid the coronavirus disease 2019 pandemic: Are we equipped?


1 Department of Pediatric and Preventive Dentistry, DAV (C) Dental College, Yamuna Nagar, Haryana, India
2 Department of Periodontics and Oral Implantology, DAV (C) Dental College, Yamuna Nagar, Haryana, India

Date of Submission30-Sep-2020
Date of Decision05-Oct-2020
Date of Acceptance07-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Neeraj Gugnani
Departments of Pediatric and Preventive Dentistry and DAV (C) Dental College, Yamuna Nagar, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_304_20

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How to cite this article:
Gugnani N, Gugnani S. Addressing the oro-dental needs of patients with cancer amid the coronavirus disease 2019 pandemic: Are we equipped?. Cancer Res Stat Treat 2020;3:875-6

How to cite this URL:
Gugnani N, Gugnani S. Addressing the oro-dental needs of patients with cancer amid the coronavirus disease 2019 pandemic: Are we equipped?. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 20];3:875-6. Available from: https://www.crstonline.com/text.asp?2020/3/4/875/304977



The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented health emergency that has gripped the world in its clutches and impacted our daily lives in many ways.[1] Dental health-care providers are considered to be at a high risk of infection with the severe acute respiratory syndrome coronavirus 2, because of the aerosol-generating procedures and their exposure to saliva and blood during dental treatment.[2] As a result of this increased risk, health authorities worldwide have suggested performing dental procedures only in case of an emergency, while deferring elective dental care. Such postponement of elective dental care is somewhat acceptable in the routine dental setup, but for patients with cancer, dental care cannot always be deferred.

In this regard, it was encouraging to read Dholam et al.'s article published in your esteemed journal that raised this issue and summarized the guidelines to provide oro-dental care for patients with cancer.[3] It is noteworthy that the authors have reported the protocols that they follow in their dental clinic which is a part of the premier tertiary care cancer hospital in India (Tata Memorial Hospital, Mumbai). It is articles like these that usually serve as a guiding document for individual dental clinics and hospitals.

Dental care in patients with cancer is required on two main occasions – before surgery and for postsurgical rehabilitation. Before surgery, dental care involves eradication of foci of oral infection to prevent the chances of chemo/radiotherapy-induced osteonecrosis.[4],[5] Postsurgery, a dentist is involved with prosthetic rehabilitation of the resected maxilla/mandibular segments that help to maintain adequate oral function, speech, and nutrition, thus positively impacting the patients' quality of life.[6]

As patients with cancer could be immunocompromised either because of the disease or the associated therapies, it becomes imperative to strictly follow all the infection control protocols, especially during the pandemic.[7] In this regard, the authors have summarized their protocol and advised thermal screening and the use of personal protective equipment for personnel safety, including N95 masks, eye cover, visor, and head cap. For operatory disinfection, the authors have advised the use of 0.5% sodium hypochlorite or hydrogen peroxide solution, and for decreasing the oral viral loads, they have advised the use of hydrogen peroxide or povidone-iodine preprocedural mouth rinses. However, the authors have mentioned that the patients who showed signs of respiratory illness were “provided with masks.” This raises an ambiguity whether, in general, the patients were allowed to enter the hospital premises without masks. For dental procedures, as per guidelines, the authors have rightly advised avoiding aerosol-generating procedures and performing nonsurgical extractions, wherever necessary.

Regarding prosthetic rehabilitation, an optimum strategy aimed at providing prosthesis in the minimum possible time should be devised so as to reduce the patients' hospital stay while minimizing their interactions with the dental care provider.[8] In this regard, although the authors have reported that the prosthesis was fabricated within a day, the details of the workflow were missing. In addition, it is unclear how the fabrication of obturators or guide bite prosthesis differed from that in the pre-COVID times which helped them reduce the fabrication time to just a day. Considering the importance of disinfection of impression, the authors have provided their protocol according to which the prostheses were immersed in a solution of 0.5% povidone-iodine and saline for 20 s before insertion. However, the authors did not mention if they are using teleconsultation, which may not completely replace the face-to-face consultation, but may help provide some palliative care and assurance to the needy patients both, before and after the surgery.[9]

In the end, it is important to understand that there still exists equipoise in most of these advocated protocols; however, we need to follow the “current guidelines” which are based on the “best evidence available as of today.” Hence, the authors have also rightly advised that dentists should keep abreast of the “latest protocols” to provide the best possible care to their patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pande P, Sharma P, Goyal D, Kulkarni T, Rane S, Mahajan A. COVID-19: A review of the ongoing pandemic. Cancer Res Stat Treat 2020;3:221-32.  Back to cited text no. 1
  [Full text]  
2.
Gugnani N, Gugnani S. Safety protocols for dental practices in the COVID-19 era. Evid Based Dent 2020;21:56-7.  Back to cited text no. 2
    
3.
Dholam KP, Sharma MR, Gurav SV, Singh GP, Manjrekar N. Dental measures during the COVID-19 pandemic in cancer patients. Cancer Res Stat Treat 2020;3:429-33.  Back to cited text no. 3
  [Full text]  
4.
Kochhar AS, Bhasin R, Kochhar GK, Dadlani H. Provision of continuous dental care for oral oncology patients during & after COVID-19 pandemic. Oral Oncol 2020;106:104785.  Back to cited text no. 4
    
5.
Kudva A, Kumar M. Clinical aspects and considerations in patients with medication-induced osteonecrosis of the jaw: A commentary. Cancer Res Stat Treat 2020;3:408-9.  Back to cited text no. 5
  [Full text]  
6.
Beacher NG, Sweeney MP. The dental management of a mouth cancer patient. Br Dent J 2018;225:855-64.  Back to cited text no. 6
    
7.
Bansal N, Ghafur A. COVID19 in oncology settings. Cancer Res Stat Treat 2020;3:13-4.  Back to cited text no. 7
  [Full text]  
8.
Brandão TB, Migliorati CA, Vechiato-Filho AJ, Silva WG, Prado Ribeiro AC, Parise-Junior O, et al. Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic. Support Care Cancer 2021;29:11-5.  Back to cited text no. 8
    
9.
Yadav V, Kumar V, Sharma S, Chawla A, Logani A. Palliative dental care: Ignored dimension of dentistry amidst COVID-19 pandemic. Spec Care Dentist 2020;40:613-5.  Back to cited text no. 9
    




 

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